Evaluating the traditional day and night shift in an acute care surgery fellowship: Is the swing shift a better choice?

Chestovich, Paul J; McNicoll, Christopher F.; Ingalls, Nichole K.; Kuhls, Deborah A.; Fraser, Douglas R.; Morrissey, Susan; Fildes, John

doi:10.1097/ta.0000000000001704

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…However, at our facility, in recent years, we have given the option to trauma surgery fellows to work a “swing shift” from noon to midnight. This option has been successful in exposing these fellows to a higher number of adult patients and operative cases 10 . We have also observed, at our institution, that the swing shift tends to expose trainees to higher acuity adult patients than the day or night shift.…”

Section: Discussionmentioning

confidence: 56%

“…This option has been successful in exposing these fellows to a higher number of adult patients and operative cases. 10 We have also observed, at our institution, that the swing shift tends to expose trainees to higher acuity adult patients than the day or night shift. We specifically assessed the pediatric trauma volume of the swing shift in our study.…”

Section: Discussionmentioning

confidence: 67%

“…However, other studies have observed that summer months have a higher incidence of pediatric trauma. 10 Until further work is done to better determine if there are months with a consistently higher frequency of pediatric trauma, the month of the year is unlikely to have a significant effect in scheduling trainees and staff to trauma services.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Trauma Arrival Times and the Swing Shift

Berg

Chestovich²,

Jones³

et al. 2020

Pediatr Emer Care

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Background: Trauma center staff and trainees are often assigned to a day and night shift. However, for adult trauma, the swing shift has been found to offer superior clinical exposure compared with a standard day or night shift for trainees. We characterized patterns in pediatric trauma arrival times based on the hour, weekday, and month and studied whether or not the swing shift also maximizes exposure to hands-on experiences in managing pediatric trauma.Methods: We performed a retrospective review of the trauma database at our urban, level 2 pediatric trauma center. We identified all the pediatric trauma activations in the last 13 years (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018). A retrospective shift log was created, which included day (7:00 AM to 7:00 PM), night (7:00 PM to 7:00 AM), and swing (noon to midnight) shifts. The shifts were compared using the Wilcoxon match-pairs signed rank test. Weekends data were also compared with weekdays, and comparisons were also made for pediatric patients with Injury Severity Scores (ISS) >15.Results: There were 3532 pediatric patients identified for our study. The swing shift had 1.98 times more activations than the night shift, and 1.33 more than the day shift (P < 0.001). The swing shift was also superior to both the day and night shifts for exposure to patients with Injury Severity Score greater than 15 (P < 0.001). Weekend days had 1.28 times more trauma than the weekdays (P < 0.001). Peak arrival time was between the hours of 3:00 PM and 9:00 PM, and patient age did not have an effect on this trend.Conclusions: Experience in managing pediatric trauma patients will improve for trainees who utilize the swing shift. In addition, the hours between 3:00 PM and 9:00 PM on weekends may represent a time of particularly high likelihood of pediatric trauma arrivals, which may require extra staff and hospital resources.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pediatric Trauma Arrival Times and the Swing Shift

Berg

Chestovich²,

Jones³

et al. 2020

Pediatr Emer Care

Self Cite

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“…However, alternative solutions exist. Trauma volume per trainee can be optimized via deliberate trainee scheduling, 21,22 focusing on the busier times of the day or the year, and use of a competency-based curricular model to minimize variability. These modifications can be further supplemented by increased use of simulation, both resuscitative and operative, and curricular innovation.…”

Section: Discussionmentioning

confidence: 99%

Development of a novel conceptual framework for curriculum design in Canadian postgraduate trauma training

et al. 2019

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Background: Recent changes in practice patterns and training paradigms in trauma care have resulted in a critical review of postgraduate curricula. Specifically, a shift towards non-operative management of traumatic injuries, and reduced resident work-hours, has led to a significant decrease in trainees' surgical exposure to trauma. The purpose of our study is to perform an exploratory review and needs assessment of trauma curricula for general surgery residents in Canada. Methods: Our study design includes semi-structured interviews with trauma education experts across Canada and focus groups with various stakeholder groups. We performed qualitative analysis of comments, with two independent reviewers, using inductive thematic analysis to identify themes and sub-themes. Results: We interviewed four trauma education experts and conducted four focus groups. We formulated two main themes: institutional context and transferability of curricular components. We further broke down institutional context into sub-themes of culture, resources, trauma system, and trauma volume. We developed a new conceptual framework to guide ongoing curricular reform for trauma care within the context of general surgery training. Conclusions: Our exploratory curriculum review of trauma care training in Canada has provided valuable data to guide a national curriculum development process.

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“…Chestovich et al found innovative scheduling to maximize patient numbers in light of work hour restrictions effective. 3 Surgical fellows increased their patient exposure when their program added a swing shift during the busiest trauma census hours. Using modeling of hourly volume trends allowed the program to match fellows with patient volume.…”

Section: Schedulingmentioning

confidence: 99%